Kaiser Permanente problems now go beyond medical malpractice cases
Over the years there have been a multitude of medical malpractice claims against Kaiser Permanente, the largest nonprofit healthcare plan and hospital system in the U.S. Recently, however, a federal case against Kaiser Permanente alleges that the healthcare giant committed fraud by misdiagnosing cases in order to “goose” revenue reimbursements.
The lawsuit claims that physicians added information to patient records, sometimes months or even more than a year after a patient’s appointment, for conditions that the patient did not have or that were not considered at the time of their original visit.
The suit further alleges that Kaiser knew, through their audit process, that physicians were improperly diagnosing certain conditions, but let the errors persist for financial gain.
Exaggerated claims could have impact on your care
Misdiagnosing cases and prescribing medications to treat misdiagnosed conditions or illnesses are just some of the factors that add to the already skyrocketing health care costs in the U.S.
Prescribing medication to people who do not actually require it has a direct impact on their health, especially if they experience dangerous side effects. Misdiagnosing cases can result in patients being treated for diseases and conditions they do not have while others do not receive treatment, some of it life-saving, for diseases or conditions they have.
The federal case against Kaiser Permanente centers around the Medicare Advantage program, also known as Medicare Part C, which allows beneficiaries to enroll in managed care insurance plans. Health plans that are participants are paid a per-person fee based on the services they provide and on the health status of the individual enrollees. According to attorneys with the DOJ, the driver for Kaiser was increased revenue.
Risk assessment scoring
Enrollees in the Medicare Advantage program receive a risk assessment score from the Centers for Medicare and Medicaid Services. A risk score is a grade based on an individual’s demographic data and on their health diagnosis.
The higher the risk score, the more a health plan is paid by the government to insure that individual. Kaiser is accused of artificially inflating risk scores of patients to increase its Medicare payouts and defrauding Medicare out of approximately $1 billion.
The DOJ’s complaint vs. Kaiser “is an “indication that Kaiser has really put profits before patients, and it’s really shocking,” according to Edward Baker, co-lead counsel in one of the six lawsuits that led to the DOJ’s complaint.
It’s also unfortunate that people who are members of Kaiser’s managed care system are suffering injuries and/or wrongful deaths due to malpractice and negligence because profit goals are put before patient care.
If you have an issue with the treatment or care you have received or are receiving from a healthcare professional employed by Kaiser, you can learn about the process of filing a complaint against Kaiser on their website. However, in many cases, filing a complaint produces little if any results.
Instead, speak with a qualified medical malpractice lawyer who will aggressively defend your rights as a victim and is familiar with the complexities of Kaiser Arbitration hearings.